Tagged / federalisation

BU conference presentation Federalisation & Nepal’s health system

The health system in Nepal’s unique federalisation experiment will be presented by Prof. Edwin van Teijlingen at a three-day conference at the Far Western University, Nepal on Saturday 8th February.  Nepal’s introduction of its federal system in the 2015 Constitution changed the way society, including its health system, was organised.  It meant that political changes and health systems changes occurred in parallel.  Prof. Edwin van Teijlingen explores the impact of federalisation on Nepal’s health system as part of an interdisciplinary mixed-methods study* called ‘The Impact of Federalisation on Nepal’s Health System: A longitudinal Analysis’.

First, implementing a new federal system is a slow, resource intensive process. While building new federal structures is important, challenging the status quo through strategic “unlearning and undoing” of old tendencies is also essential, as this creates spaces for new approaches that are more in line with federalism. This requires attention to emotional and political spheres, and not just structural or technical ones.

Federalisation, generally, brought decision making, resources and service delivery closer to the people, yet the process remains challenging and incomplete. Importantly, at the same time as federalism was being introduced, Nepal’s health system had to respond to COVID-19, making it difficult to disentangle the effects of the pandemic from those of federalisation. The health system is also part of a broader, complex, and interdependent set of socio-political, economic, legal, and cultural systems.

We found that the impact of federalisation varied across the six WHO building blocks and pre-existing conditions, e.g. wealthier regions often benefit disproportionately, exacerbating inequities in health.  Our study further highlighted: (a) the importance of leadership and governance, combined with financing mechanisms; (b) insufficient planning and misalignment between central and local levels resulting in inefficiencies; (c) weak health information systems hinder the ability to measure long-term effects.  Overall, unlocking the full potential of federalism will require political will and commitment at all three levels of government.

To date eight papers have been produced based in this project [1-8].

 

References:

  1. Koirala, B., Rushton, S., Adhikary, P., Balen, J., et al. (2024) COVID-19 as a challenge to Nepal’s newly federalised health system: capacities, responsibilities, and mindsets, Asia Pacific Journal of Public Health (online first) https://doi.org/10.1177/1010539524125012.
  2. Sapkota, S., Rushton, S., van Teijlingen, E., et al. (2024) Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research & Policy Systems22 (No.7) https://doi.org/10.1186/s12961-023-01092-5 .
  3. Wasti, S.P., van Teijlingen, E., Simkhada, P., et al. (2023) Selection of Study Sites and Participants for Research into Nepal’s Federal Health System, WHO South-East Asia Journal of Public Health 12(2):116-119.
  4. Sapkota, S., Dhakal, A., Rushton S., et al. (2023) The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health 8:e013317. doi:10.1136/bmjgh-2023-013317.
  5. Wasti, S.P., van Teijlingen, E.Rushton, S., et al. (2023) Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks, Health Research Policy & Systems 21(117https://doi.org/10.1186/s12961-023-01033-2
  6. Sapkota, S., Panday, S., Wasti, S.P., et al. (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of the Nepal Public Health Association 7(1):36-42.
  7. Adhikary, P., Balen, J., Gautam, S., et al. (2020) The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system, Journal of Karnali Academy of Health Sciences (3): 1-11.
  8. Rushton, S., Pandey, S., van Teijlingen, E., et al. (2021) An Investigation into the Impact of Decentralization on the Health System of Nepal. Journal of Manmohan Memorial Institute of Health Sciences7(1): 3–14. https://doi.org/10.3126/jmmihs.v7i1.43146

Federalisation & health research presented in Nepal

Last month we reported on this Bournemouth University Research Blog (click here!) that Ms. Amshu Dhakal, presented findings from our Nepal Federal Health System Project in Nepal.  Amshu’s presentation at the Nepal Health Conclave 2024, organised by the Ministry of Health and Population and supported by WHO (World Health Organization) Nepal and UNFPA, resulted in an online article in Nepal.  This article in Nepali in Swasthya Khabar Patrika features lessons learnt and evidence from our research project “The Impact of Federalisation on the Health System of Nepal.”
Our project ran from 2020 to 2024, and it was funded by the Health System Research Initiative, a UK collaboration between three funders: the MRC (Medical research Council), the Foreign, Commonwealth & Development Office, and the Welcome Trust.  This joint project was led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, Canter Bury Christ Church University and two institutions in Nepal, namely Manmohan Memorial Institute of Health Sciences and PHASE Nepal.  In 2023 further funding was awarded by the Medical Research Foundation to Prof. Julie Balen, from Canterbury Christ Church University, to disseminate the findings in Nepal.  Furthermore, to date we have published eight papers from this interdisciplinary project [1-8].
This is one of several news articles from this project which have appeared in both English and Nepali in national media in Nepal.  In early 2024 two daily English-language media outlets: The Annapurna Express and Gazzabkoo Magazine published articles covering our project.  The latter used the title ‘Strengthening Health Systems for Better Health‘ and the former opted for the headline ‘Forum on health system strengthening’.
In the same month last year three UK professors: Julie Balen (Canterbury Christ Church University), Simon Rushton (the University of Sheffield) and Edwin van Teijlingen (Bournemouth University) were interviewed (see interview here) about the study.  Our interdisciplinary research project ‘The impact of federalisation on Nepal’s health system: a longitudinal analysis’ was also previously reported in several national media in Nepal in the spring of 2023. 
 
Prof. Edwin van Teijlingen
Centre of Midwifery & Women’s Health.
References:
  1. Koirala, B., Rushton, S., Adhikary, P., Balen, J., et al. (2024) COVID-19 as a challenge to Nepal’s newly federalised health system: capacities, responsibilities, and mindsets, Asia Pacific Journal of Public Health (online first) https://doi.org/10.1177/1010539524125012.
  2. Sapkota, S., Rushton, S., van Teijlingen, E., et al. (2024) Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research & Policy Systems22 (No.7) https://doi.org/10.1186/s12961-023-01092-5 .
  3. Wasti, S.P., van Teijlingen, E., Simkhada, P., et al. (2023) Selection of Study Sites and Participants for Research into Nepal’s Federal Health System, WHO South-East Asia Journal of Public Health 12(2):116-119.
  4. Sapkota, S., Dhakal, A., Rushton S., et al. (2023) The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health 8:e013317. doi:10.1136/bmjgh-2023-013317.
  5. Wasti, S.P., van Teijlingen, E.Rushton, S., et al. (2023) Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks, Health Research Policy & Systems 21(117https://doi.org/10.1186/s12961-023-01033-2
  6. Sapkota, S., Panday, S., Wasti, S.P., et al. (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of the Nepal Public Health Association 7(1):36-42.
  7. Adhikary, P., Balen, J., Gautam, S., et al. (2020) The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system, Journal of Karnali Academy of Health Sciences (3): 1-11.
  8. Rushton, S., Pandey, S., van Teijlingen, E., et al. (2021) An Investigation into the Impact of Decentralization on the Health System of Nepal. Journal of Manmohan Memorial Institute of Health Sciences7(1): 3–14. https://doi.org/10.3126/jmmihs.v7i1.43146

Impact of federalisation on Nepal’s health system

On Boxing Day and the following day (Dec. 27th) a member of our research team, Amshu Dhakal based at Manmohan Memorial Institute of Health Sciences (MMIHSS), presented findings from our Nepal Federal Health System Project in Kathmandu.  The event, Nepal Health Conclave 2024, was organised by the Ministry of Health and Population and supported by WHO (World Health Organization) Nepal and UNFPA.  The event aimed to help strengthen Nepal’s health services.  This year’s conclave, themed “Bridging the Gap Between Global Expertise and National Needs”, brought together Nepalese diaspora health professionals and national stakeholders to foster collaboration and innovation in health systems.

Amshu presented two posters at the event: (1) The Impact of Decentralisation on Health Systems: A Systematic Review of Reviews which systematically reviewed how decentralisation affects health systems globally, highlighting key opportunities and challenges across WHO’s six building blocks; and (2) Transforming the Health System in Nepal: The Impact of Federalisation, which examined how the transition to a federal system reshaped Nepal’s health system, identifying gaps, opportunities, and actionable recommendations for improvement.

Our research team produced policy briefs in collaboration with government officials/stakeholders from all three levels of government.  The policy briefs can be accessed at the website of our Nepal Federal Health System Project.  This study was funded by the UK Health Systems Research Initiative [Grant ref. MR/T023554/1] to study the consequences for the health system of Nepal’s move from a centralised political system to a more federal government structure in 2015.  This joint project was led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, Canter Bury Christ Church University and two institutions in Nepal, namely MMIHS and PHASE Nepal. 

In late 2022 further funding was awarded by the Medical Research Foundation to Prof. Julie Balen, from Canterbury Christ Church University, to disseminate the findings of our UK Health Systems Research Initiative-funded research in Nepal. In terms of academic dissemination, we have published eight papers from this interdisciplinary project [1-8].

 

Prof. Edwin van Teijlingen

Centre for Midwifery & Women’s Health

 

References:

  1. Koirala, B., Rushton, S., Adhikary, P., Balen, J., et al. (2024) COVID-19 as a challenge to Nepal’s newly federalised health system: capacities, responsibilities, and mindsets, Asia Pacific Journal of Public Health (online first) https://doi.org/10.1177/1010539524125012.
  2. Sapkota, S., Rushton, S., van Teijlingen, E., et al. (2024) Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research & Policy Systems22 (No.7) https://doi.org/10.1186/s12961-023-01092-5 .
  3. Wasti, S.P., van Teijlingen, E., Simkhada, P., et al. (2023) Selection of Study Sites and Participants for Research into Nepal’s Federal Health System, WHO South-East Asia Journal of Public Health 12(2):116-119.
  4. Sapkota, S., Dhakal, A., Rushton S., et al. (2023) The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health 8:e013317. doi:10.1136/bmjgh-2023-013317.
  5. Wasti, S.P., van Teijlingen, E.Rushton, S., et al. (2023) Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks, Health Research Policy & Systems 21(117https://doi.org/10.1186/s12961-023-01033-2
  6. Sapkota, S., Panday, S., Wasti, S.P., et al. (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of the Nepal Public Health Association 7(1):36-42.
  7. Adhikary, P., Balen, J., Gautam, S., et al. (2020) The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system, Journal of Karnali Academy of Health Sciences (3): 1-11.
  8. Rushton, S., Pandey, S., van Teijlingen, E., et al. (2021) An Investigation into the Impact of Decentralization on the Health System of Nepal. Journal of Manmohan Memorial Institute of Health Sciences7(1): 3–14. https://doi.org/10.3126/jmmihs.v7i1.43146

Media coverage in Nepal

Last week Mr. Yogesh Dhakal, who is Deputy Editor at Shilapatra, an online newspaper in Nepal, interviewed three UK professors: Julie Balen (Canterbury Christ Church University), Simon Rushton (the University of Sheffield) and Edwin van Teijlingen (Bournemouth University).  The focus of the interview (see interview online here) was our recently completed interdisciplinary study ‘The impact of federalisation on Nepal’s health system: a longitudinal analysis’.

In this Nepal Federal Health System Project we studied the consequences for the health system of Nepal’s move from a centralised political system to a more federal structure of government.  This three-year project is UK-funded by the MRC, Wellcome Trust and FCDO (Foreign, Commonwealth & Development Office; formerly DFID) under the Health Systems Research Initiative.  This joint project is led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, Canterbury Christ Church University and two  institutions in Nepal, namely MMIHS (Manmohan Memorial Institute of Health Sciences) and PHASE Nepal. 

Today (23rd January) the article appeared online in Nepali.  We have seen the transcript in English of the actual interviews with the three of us, but I have no idea how the journalist has edited, selected and translated the relevant text.

Prof. Edwin van Teijlingen

CMWH (Centre for Midwifery & Women’s Health)